本文通过对侯氏黑散的源流、配伍特点、方证内涵进行探析,可知此方是张仲景博采众方所得,其"寒热温凉熔于一炉,清散补泄集于一方"的组方特点体现了中医"寒热并用"的方剂配伍理论.全方具有温阳益气养血、祛风清热化痰,内外风同治之功,主治以气血亏虚,运行不畅,复感外邪,痰湿郁热,引动肝风,痹阻经脉为主要病机的"大风".侯氏黑散治寒、热、虚、实各有所为,治风、痰、气、血、瘀、热面面俱到,是中医治疗中风的"第一方",其方证内涵与气虚血瘀型缺血性中风的病因病机相合,故分析总结侯氏黑散与缺血性中风的关系及其治疗缺血性中风的特点和理论,以期为侯氏黑散的运用提供新思路.

介绍杨志宏教授运用清心宁神汤异病同治的相关理论与经验.杨志宏教授以"谨守病机"为临证要点,发现不寐中有以肾水不足、心火亢盛而致心神失养者;郁证中有以心肝火旺导致情绪烦躁,日久成郁者;眩晕中有以肝肾亏虚而致阴虚火旺,灼津为痰,出现痰火上蒙脑窍而发病者.上述病证虽临床表现不同,实则皆以阴虚火旺、水火不济为基本病机,均可运用清心宁神汤以清心安神、滋阴降火,不仅临床疗效显著,更体现了中医学辨证论治思想的精髓——异病同治.现从清心宁神汤的立方溯源、方药释义、临证经验、典型医案等方面阐述杨志宏教授运用此方异病同治的经验与理论,以期更好地将名医经验指导于临床,为异病同治提供临床思路.

失眠是由于各种原因导致的无法入睡或不能保持睡眠状态的一种疾病,常给患者带来极大的痛苦和心理负担.目前治疗失眠的药物,尤其是治疗服用不同剂量激素后出现失眠的药物,大多会使患者产生依赖性和耐受性.杨志宏主任医师从整体观出发,充分把握疾病的演变规律,抓住主要病机,分清虚实,对激素相关性失眠的患者,采取分阶段辨证论治,并自拟清心宁神汤,形成了中医治疗激素相关性失眠的诊疗方案,临床疗效佳.

目的 探讨养血清脑丸对慢性脑供血不足患者的疗效及对认知功能的影响.方法 选择慢性脑供血不足患者78例,随机分为两组,各39例.对照组单用倍他司汀,观察组联用养血清脑丸.结果 观察组治疗有效率明显高于对照组(P＜0.05);治疗后,两组患者的血清内皮素水平、血小板聚集率、纤维蛋白原和血浆黏度较治疗前降低,且观察组低于对照组;两组血清一氧化氮水平及Mo CA评分较治疗前升高(P＜0.05),且观察组高于对照组(P＜0.05).结论 养血清脑丸能改善慢性脑供血不足患者的内皮细胞功能、认知功能和血液流变学,提高疗效,值得推广.

帕金森病是一种多发于中老年的神节系统变性疾病.杨志宏教授治疗帕金森病独具特色,注重滋补肝肾以固本;在化痰祛瘀的同时,注重益气;倡导清热除湿、解毒排毒以护脑;常用解表除湿的方法治疗汗出,疗效显著.

目的:探讨针刺联合化痰通络汤治疗缺血性脑卒中(CIS)后遗症期的临床疗效.方法:选取94例CIS后遗症期患者,随机分为对照组和观察组,每组47例.对照组在西医常规对症治疗的基础上给予针刺治疗,观察组在对照组治疗基础上加用化痰通络汤口服治疗.比较两组临床疗效及治疗前后神经功能缺损程度评分(NDS)、功能综合评定量表(FCA)评分.结果:观察组总有效率为93.62％(44/47),高于对照组的74.47％(35/47),差异有统计学意义(P<0.05).治疗后,两组NDS评分均较治疗前降低(P<0.05),FCA评分均较治疗前升高(P<0.05);观察组NDS评分低于对照组(P<0.05),FCA评分高于对照组(P<0.05).结论:针刺联合化痰通络汤治疗CIS后遗症期可有效改善患者的临床症状,促进神经功能修复.

脑出血是一种非外伤性的脑实质自发性出血, 与糖尿病、高血压、高脂血症、血管老化等因素有密切联系,多在过度劳累或情绪激动时突然发作 [1]. 急性脑出血的发病率为30％～40％,具有发病率高、病情风险大、病情进展迅速、死亡率高等特点. 因此,准确及时的诊断和治疗是提高患者生存率的关键环节[2,3]. 目前,急性脑出血的临床诊断首选影像学检查,主要包括螺旋CT、磁共振成像(MRI)等,MRI扫描人体软组织的分辨率较高,可以进行多方向、多序列成像.MRI在立体显示病灶具体位置、血肿形态、大小及血肿分期等方面具有较大优势[4,5]. 鉴于此,本研究探讨急性期脑出血多序列MRI的影像特征及诊断价值. 具体分析如下.

目的:观察化痰通络解痉汤联合康复训练治疗脑卒中后肢体痉挛患者的临床疗效.方法:将87例患者随机分为两组.对照组43例,给予康复训练治疗,观察组44例,在此基础上联合化痰通络解痉汤进行治疗.观察两组患者的痉挛程度、运动能力(fugl-meyer assessment,FMA)、日常生活能力评分(barthel index,BI)、血清神经特异性烯醇酶(neuron specific enolase,NSE)和C反应蛋白(C-reactive protein,CRP)水平.结果:治疗后,两组改良Ashworth量表(modified ashworth scale,AS)评分,NSE、CRP水平均显著低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组FMA和BI评分均显著高于治疗前,且观察组高于对照组(P<0.05).结论:化痰通络解痉汤联合康复训练可有效改善脑卒中后肢体痉挛患者的痉挛程度、提高运动能力和日常生活能力,降低血清NSE、CRP水平.

目的:探讨清金化痰汤对卒中相关性肺炎患者C反应蛋白(C-reactive protein,CRP)、白细胞(white blood cell,WBC)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平的影响.方法:将81例患者根据入院顺序随机分为观察组40例、对照组41例,对照组给予头孢哌酮钠舒巴坦钠治疗,观察组在此基础上给予清金化痰汤治疗,两组治疗观察时间为1周,对比两组治疗效果.结果:总有效率观察组为92.5％(37/40),对照组为75.6％(31/41),2组比较差异有统计学意义(P<0.05).美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)及临床肺部感染评分(clinical pulmonary infec-tion score,CPIS)评分治疗前两组比较,差异无统计学意义(P>0.05);治疗后,两组均显著下降,治疗前后组内比较,差异有统计学意义(P<0.05),治疗后组间比较,差异有统计学意义(P<0.05).CRP、WBC、hs-CRP治疗前两组比较,差异无统计学意义(P>0.05);治疗后,两组积分均显著下降,治疗前后组内比较,差异有统计学意义(P<0.05),治疗后组间比较,差异有统计学意义(P<0.05).结论:清金化痰汤可有效改善卒中相关性肺炎患者的CRP、WBC、hs-CRP水平,缓解临床肺部感染症状和神经功能缺损程度,治疗效果显著.

目的 观察养血清脑颗粒治疗紧张性头痛的临床疗效.方法 将68例紧张性头痛患者按就诊顺序随机分为两组,对照组与治疗组各34例.对照组给予非甾体类镇痛消炎药布洛芬缓释胶囊及抗焦虑抑郁药氟哌噻吨美利曲辛常规治疗,治疗组在对照组治疗的基础上给予养血清脑颗粒.结果 治疗组在缩短头痛发作持续时间、疼痛数字评分(NRS)、汉密顿焦虑量表(HAMA)评分、汉密顿抑郁量表(HAMD)评分及不良发应等方面优于对照组,具有可比性(P＜0.05).结论 养血清脑颗粒治疗紧张性头痛具有更好的临床疗效,临床上可进一步推广应用.

目的 观察清心宁神汤治疗失眠合并焦虑抑郁的临床疗效.方法 将78例失眠合并焦虑抑郁病人随机分为两组,各39例.对照组给予苯二氮卓类催眠药治疗,治疗组在对照组基础上加用清心宁神汤加减治疗,两组疗程均为4周.治疗前后分别对两组病人进行匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)、汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)、汉密顿抑郁量表(Hamilton Depression Scale,HAMD)测评.结果 治疗后治疗组PSQI评分、HAMA评分、HAMD评分、病情复发率以及不良反应等方面均优于对照组(P<0.05).结论 基础治疗联合清心宁神汤治疗失眠伴焦虑抑郁可改善病人PSQI评分、HAMA评分、HAMD评分等,临床疗效确切.

目的 观察调脂柔脉颗粒治疗脑动脉硬化症的临床疗效.方法 将72例门诊患者按就诊顺序随机分为对照组与治疗组,每组各36例.对照组给予拜阿司匹林和阿托伐他汀钙片治疗,治疗组在对照组治疗的基础上加用调脂柔脉颗粒,疗程均为12周.治疗前后分别对两组患者临床疗效、脑血流动力学指标、血脂水平及颈动脉斑块面积进行分析比较.结果 治疗组临床疗效明显优于对照组;治疗后脑血流动力学指标PI、RI较治疗前减小,MCA及VA的Vs较前增大,且治疗组的PI、RI较对照组缩小明显,MCA及VA的Vs较前治疗前增大明显;治疗后的血脂水平低于治疗前;且治疗组血脂水平低于对照组;治疗后的颈动脉斑块面积均低于治疗前;且治疗组颈动脉斑块面积均低于对照组.以上各项指标均具有可比性(P＜0.05).结论 调脂柔脉颗粒治疗脑动脉硬化症临床疗效,值得临床上进一步推广应用.

目的:观察氟桂利嗪联合血府逐瘀汤加减治疗偏头痛的临床疗效及对血管内皮功能、血流动力学的影响.方法:将72例患者按就诊顺序随机分为观察组、对照组,每组36例.对照组于每晚睡前口服氟桂利嗪治疗,每次10 mg,观察组同时以血府逐瘀汤加减治疗,15天后比较2组的临床治疗效果.结果:总有效率观察组为94.44％(34/36),对照组为77.78％(28/36),2组比较,差异有统计学意义(P<0.05);血浆内皮素水平及最大峰值流速、平均流速、血管阻力指数、搏动指数治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05).结论:氟桂利嗪联合血府逐瘀汤加减治疗偏头痛的临床效果显著优于单纯使用氟桂利嗪治疗,其作用机制可能与改善血管内皮功能以及血流动力学相关.

目的 观察天麻眩晕宁合剂治疗痰浊中阻型颈性眩晕的临床疗效.方法 将182例患者随机分为两组,治疗组92例给予天麻眩晕宁合剂口服,30ml/次,3次/d;对照组90例给予盐酸氟桂利嗪胶囊口服,5mg/晚.疗程均为14天,观察2组治疗后的临床疗效.结果 治疗组总有效率90.21％,对照组总有效率70.00％,2组疗效比较,差异有统计学意义(P＜0.05).结论 天麻眩晕宁合剂治疗痰浊中阻型颈性眩晕疗效确切,值得临床进一步推广.

目的:观察针刺治疗帕金森病的临床疗效,方法:将76例患者随机分为观察组、对照组各38例,对照组予以美多芭治疗,初始剂量为半片,每天服用3次,服用1周后,每周的日用剂量增加半片,直到患者病情得到明显缓解为止.观察组在对照组治疗的基础上采用针灸治疗.对比2组患者运动功能评定结果、临床疗效、美多芭用量情况.结果:步距和运动完成时间治疗前后2组组内比较,差异有统计学意义(P＜0.05);治疗后2组组间比较差异也有统计学意义(P＜0.05).总有效率观察组为97.37％,对照组为78.95％,2组比较差异有统计学意义(P＜0.05).美多芭用量观察组治疗前后比较,差异有统计学意义(P＜0.05);治疗后2组组间比较差异也有统计学意义(P＜0.05).结论:针刺治疗帕金森病临床疗效显著,可显著改善患者运动功能,减少药物的摄入量.

目的 研究补益肝肾汤对肝肾不足型帕金森病患者日常生活能力、睡眠障碍改善的临床疗效.方法 68例肝肾不足型帕金森病患者,随机分为对照组和治疗组,每组各34例.对照组患者给予美多巴治疗,治疗组患者在西药治疗的同时,给予补益肝肾汤每日一剂,疗程3个月,比较两组患者的中医证候积分、统一帕金森病评定量表评分中的日常生活能力、睡眠质量的改善情况.结果 治疗组患者的总有效率与睡眠质量评分比对照组明显增加(P＜0.05),中医证候积分与统一帕金森病评定量表中的日常生活活动评分比对照组明显减少(P＜0.05),两组的不良反应发生率没有统计学的差异(P＞0.05).结论 中药补益肝肾汤能够有效地改善肝肾不足型帕金森病患者的日常生活质量与睡眠质量,没有明显地不良反应,值得临床应用.

目的 观察中西医结合治疗下肢动脉粥样硬化闭塞症的临床疗效.方法 将82例下肢动脉粥样硬化闭塞症病人按就诊顺序随机分为治疗组(40例)与对照组(42例),两组病人均给予抑制血小板聚集、调脂稳定斑块、抗炎等常规治疗;治疗组在常规治疗基础上加服调脂柔脉颗粒,每次10 9,每日3次,疗程均为3个月.观察两组治疗前后临床疗效、踝-肱指数变化.结果 治疗组临床疗效总有效率87.50％,明显高于对照组的69.05％,差异有统计学意义(P＜0.05);治疗组治疗后踝-肱指数为1.28±0.06,对照组治疗后踝-肱指数为0.81±0.07,治疗组高于对照组,差异有统计学意义(P＜0.05).结论 在常规治疗基础上加服调脂柔脉颗粒可有效改善下肢动脉粥样硬化闭塞症病人的临床症状,提高踝-肱指数.

Objective: To explore the clinical Efficacy of shuxuening injection combined with dopamine hydrazine in the treatment of Parkinson's disease and its effect on the blood flow and serum inflammatory factors. Methods: 94 patients with Parkinson's disease who were treated from September 2014 to September 2017 in our hospital were selectd and divided into the control group and the research group according to the random number table method, with 47 cases in each group. The control group was treated with dopamine hydrazine, and the research group was treated with shuxuening injection based on the control group. Then the clinical curative effect, change of UP-DRS Ⅱ score, UPDRS Ⅲ score, UPDRS score, cerebral blood flow, the serum Interleukin-1β (IL-1β), interleukin 6 (IL-6), hypersensitive c-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) levels before and after treatment, and the incidence of adverse reactions were compared between two groups. Results: After treatment, the total effective rate of research group was higher than that of the control group (P＜0.05), the UPDRS Ⅱscore, UPDRS Ⅲscore, UPDRS score, serum levels of IL-1β, IL-6, hs-CRP and TNF-αof both group were significantly decreased than those before treatment, and the above indicators of research group were significantly lower than those of the control group (P＜0.05). The blood flow in the brain area of both groups were significantly higher than those before treatment, which was more obviously in the research group than that in the control group (P＜0.05). Nausea, dizziness, insomnia and vomiting were found in both groups, but significant difference was found between two groups (P＞0.05). Conclusion: Shuxuening injection combined with dopamine hydrazine is more effective in the treatment of Parkinson's disease than dodohydrazine alone, it can promote the brain blood circula-tion, regulate the brain blood flow, reduce the levels of inflammatory factors.

Objective To investigate the clinical effect of retention enema combined with western medicine in treatment of hepatic encephalopathy.Methods Selected 82 cases of patients with hepatic encephalopathy who were treated in our hospital from January 2012 to December 2016, divided into two groups randomly, 41 cases in observation group, 41 cases in control group.Two groups of patients were treated with lower blood ammonia generation, elimination of incentives, reduces the blood ammonia, liver protection, prohibit protein intake, plasma complement and branched chain amino acids.The control group was treated with western medicine, intravenous Xingnaojing and L-ornithine-L-aspartate; The observation group used a combination of Awaking decoction, 12h interval.The clinical effects of the two groups were compared. The disappearance time and the recovery time of the flapping wing tremor in the two groups were observed, and the blood ammonia levels of 3 d, 5 d, 7 d in the two groups before and after treatment were compared.Results After treatment, the effective rate of the observation group was 90.24％, significantly higher than that of the control group 75.61％ (P<0.05); The disappearance time and the recovery time of the flapping wing tremor in the observation group were significantly shorter than those in the control group (P<0.05); The average level of serum ammonia in the two groups was significantly higher than that before treatment (P<0.05), and the observation group was significantly higher than that of the control group (P<0.05). Conclusion Awaking decoction retention enema combined with western medicine clinical effect in the treatment of hepatic encephalopathy is better than pure western medicine treatment, can effectively promote the discharge of blood in patients with hepatic encephalopathy ammonia, accelerate the recovery of clear, safe and effective, it has high value in clinical application.

目的 探讨调脂柔脉颗粒对症状性颈动脉粥样硬化的血脂及颈动脉内膜的影响.方法 将90例颈动脉粥样硬化的患者随机分为治疗组和对照组,治疗组60例,对照组30例,对照组给予阿托伐他汀钙和阿司匹林肠溶片治疗,治疗组在对照组基础上加用脂柔脉颗粒,共12周,观察血脂、颈动脉B超.结果 两组的双侧颈动脉IMT厚度较治疗前均有所减少(P＜0.05),组间比较无明显差异(P＞0.05);两组颈动脉粥样硬化Crouse积分经治疗后均呈下降趋势,组间比较无显著差异(P＞0.05),治疗组TC、LDL-C改善方面优于对照组,差异有统计学意义(P＜0.05).结论 调脂柔脉颗粒联合西药能降低颈动脉粥样硬化患者的血脂水平,延缓颈动脉硬化的发展.